Students
by BankyB
Summary: William White, Benton's student, does an ER rotation with Carter. Part 2A now up. Part 2B (the conclusion) to follow.
1. Part 1

Students by [Banky][1]

    I've been in the waiting area for about a half hour when the old lady sitting next to me asks, "Young man, would you like a cough drop?" 

    I don't have a cough. Neither does she, as near as I can tell. But she sure smells like a bag full of them. "No thank you ma'am," I reply. 

    "Well you should, because these waiting rooms are full of germs," she lectures, and crunches down on another one, breathing mentholyptus into my face. 

    Looking around (and away from her breath), I can see there are probably plenty of germs here already, and it's only about 7:30. Sitting across from me is a 60-year-old black male with what appears to be a smoker's cough and a tremor. Over in the corner is a white female, age about eight, with a killer sunburn. She's sitting next to her mother, shivering in the air conditioning. Huddled next to the cough drop lady is a white male, early twenties, agitated and rubbing his nose. Probably here for his methadone. 

    I'm probably going to be taking these people's histories by the time the morning is through, and I don't know what to say to any of them. Yeah, I'm scared. This is the ER, and you got to have people skills. That's the one thing I remember from what Dr. Benton told me. 

    I get up and go to the main desk again, and there's a different clerk there now -- fat white guy with a buzzcut. "Hi," I say. "Uh, I was told to sit here by the other guy, but..." 

    Buzzcut is not interested, and doesn't even look up. "A nurse will be out to see you in a few minutes." 

    "I'm a third-year, I'm supposed to start my ER rotation today." 

    "Uh-huh," he snorts. "How many times have I heard _that_ one before." 

    "_I've_ never heard that one before," says a nurse brightly as she hurries by, smiling at me. 

    "You'd be surprised what they'll say to get back there to see one of their homeys," Buzzcut tells her. 

    The nurse rolls her eyes at him and looks at me sympathetically. But... 

    "Why don't you go have a seat in chairs?" 

    Five minutes later, I'm just about to unwrap a cough drop when I see Dr. Benton walking by. "Yo, Dr. Benton!" I jump up and say in relief, immediately regretting the "Yo" part. But he seems glad to see me, and we shake hands. "Is there a special password to get in here?" I ask. 

    "No, no," Dr. Benton reassures me, a little embarrassed. "Lydia, who's attending today?" 

    "Carter," says Smiling Nurse. 

    "Go get him for us, could you?" She goes off and Dr. Benton looks at me. "Hey, so how was your summer?" 

    I had a great summer. Interning with the CDC, running labs at the Southside Pedes Clinic, and delivering pizza. I want to tell him all about it, because if it weren't for him, I probably would have gotten no internships at all. I haven't had a chance to talk to him since May, in fact. But of course, there isn't time for personal stuff, so I just say it was cool. 

    "That's good, man, that's good. You ever meet Dr. Carter?" 

    A doc comes walking fast down the hallway with another nurse, reeling off an order for an amazing string of labs -- I only recognize about half of them -- and then comes down toward us. Tall guy, nervous walk, in a hurry, looking tired but way too energetic for this hour of the morning. And in shirt and tie, wearing his white coat, unlike most of the staff who look to be in scrubs. At least I'm not the only person all dressed up on this hot day. Dr. Benton introduces us. This is Dr. Carter. 

    "I'd like you to take White here around today and get him started," Dr. Benton is saying to him. 

    "Sure," says Dr. Carter to me with a smile. "I've got a couple nurses who are just dying to meet you -- " 

    "No, I don't want him running labs all morning," Dr. Benton says, cutting him a little short. "Can you have him do sutures, or maybe stand in on some traumas?" 

    "Yeah, sure," Dr. Carter says, giving me a funny little look. He sounds kind of surprised. I thank Dr. Benton, having trouble covering up the fact that I'm excited not to be doing labs. 

    "You're welcome. And hey, maybe I'll see you later and you can tell me how it goes." 

    I follow Dr. Carter back to the nurses' station, where everything looks strange and complicated. I try to keep my eyes wide open. Chart rack, check. Patient board, over there. I tell Dr. Carter that I'm surprised the ER is so quiet, the day after the Fourth of July. 

    "Well, it gets that way sometimes," he tells me paternally, reading a chart. 

    "The last time I was down here, it was a couple years ago. I remember there was a real bad train accident. Things were really crazy." 

    Dr. Carter just nods absently. I notice he needs a shave. Maybe he's been on duty all night, and he's tired. Might explain why he's not the friendliest guy. It's hard to tell exactly how old he is, too, but he can't be much older than 30. When he asks one of the nurses about the patient whose chart he's reading, I suddenly recognize the voice: he's the doctor I hung up the phone on the night of the train crash! Wonder whatever happened to the poor guy whose legs he was cutting off? Probably not a great time to ask, though. 

    "Ooh," a hearty woman's voice says at my ear, "a new med student!" 

    I turn around to see a big nurse who looks like she could be my Aunt Charlette's twin sister, and she's got a wicked grin. 

    "Forget it, Haleh," Dr. Carter tells her. "This is William White. Mr. White is not to run labs." 

    "Linda and Timothy have both gone home," she protests. "What do you expect me to do, pull my nurses off their breaks?" 

    "If it were up to me..." 

    "Well, you're the attending. Just who is it up to?" Haleh wants to know. 

    "Benton." 

    Dr. Carter dumps the chart back into the rack and picks up another. I can tell Haleh is pissed off, but she doesn't say anything more. Neither does Dr. Carter. I start to feel uncomfortable, like there's some kind of natural order being violated that I don't know about, or some kind of hush-up rule. I ought to say something. "You know, anything you need me to do, I can do," I offer, but Haleh's already somewhere else. 

    "William, there's nothing more I'd love to have you do than run a cup of pee up and down stairs all day," Dr. Carter answers, turning to me with a sigh. "But you're Dr. Benton's student and that isn't what he wants you to be doing." He hands me the chart. "Let's go look at some patients, shall we?" 

    I follow him down the hall, and I don't much like how I feel at the moment. I also have got a sinking feeling in my gut that I don't really much like Dr. Carter. It's because I feel he doesn't much like _me_ for some reason. Before I can stop myself, I'm thinking about how I was sitting back in chairs for 45 minutes before anyone would give me the time of day. They thought I was a banger, even in my clothes. But I don't want to start off my first day in a tough rotation being resentful of that. You can't go through life judging people, even if they act like they know all about who you are and where you come from. 

    "Yo Carter!" a guy yells from somewhere behind us. 

    I turn, and almost get whacked in the head with something. But Dr. Carter, without missing a beat, leans over like a cat and catches... a football? "Way to go, Malik, you almost took his head off." 

    But he's not really mad. He leans back and tosses the football over to the guy. It's a real football, not a foam one, and I just stand there like an idiot, staring. First of all, I've seen blood and guts, but I never saw a brother in pink scrubs before. Dr. Carter must notice my confused look, because he says, "You probably haven't met too many of the nurses yet, huh?" 

    "Hey Carter," Malik says, coming over, "I got a scalp lac for your student." 

    "He's Benton's student, actually," Dr. Carter corrects him, and Malik makes a knowing little "O" with his lips. But he takes the chart from Malik and gives it to me. "Well, if there's a trauma coming in, William, I'll, uh... come get you." He gives me a formal little pat on the arm and then he's off to more important things. 

    A few minutes later, I'm shakily suturing my very first ER patient in one of the exam rooms, a drunk old guy who's thankfully fast asleep. Malik is sort of hanging around watching me do it. He tells me it gets real crazy in the ER sometimes and that I'm lucky to be starting on the day after the Fourth of July weekend. I ask him if any of the patients or equipment ever get hurt from people playing football in the hall. 

    "Nah, we only play when Dr. Carter's around," he tells me. "Carter's cool, man. You're gonna get an _education_ with him." And then he laughs. 

    Okay, so maybe Dr. Carter is really a good teacher after all, and doesn't have a problem with people from my end of town. But, as he gives me more sutures and debridements and rectals (ugh) all morning, I still can't figure out why there's that little bit of coolness in the way he treats me. It's not just my imagination, is it? 

    Around ten, I've finished up on a little kid with a bee sting and take the chart down the hall, but there's this sudden commotion. People are running. Something's coming. Confused, I drift down toward the noise, but suddenly I'm grabbed from behind. It's him. He shoves a yellow trauma gown at me, and a pair of goggles. 

    "Okay, look alive. Come on, you're with me. Take him to Trauma One," Dr. Carter calls down the hallway to the paramedics, who are running a gurney with a patient right toward us. One of them riding on top doing compressions. "What have we got?" 

    "Thirty-year-old male, knife wound to the left chest, down 20 minutes, we got him back but he just arrested again as we pulled in," gasps one of the paramedics. "Lost his pulse. I think he's stopped breathing now too." 

    "What's his pressure?" 

    "Huh, we can't _get_ one," says the paramedic as we transfer the guy onto the table. Everyone in the trauma room starts buzzing like flies around trash. The paramedics split, and I try to stay out of the way of Haleh and the smiling nurse from earlier. She's not smiling now. "This guy has _no_ BP," she confirms. 

    I try to do something helpful and start cutting his clothes off, but Dr. Carter tells me to stop and let the nurses do that. "OK William, look at the monitor, what's happening here?" 

    I look hard. Finally: "It's... I think it's, uh, fine ventricular fibrillation." 

    "Bing," he says, sounding impressed. "Someone's got good vision." 

    "Pupils fixed and dilated," Haleh says. 

    Dr. Carter is now barking orders right and left like a cop, and I'm not about to tell him that I've never seen fine v-fib before and that I just guessed. I don't know half of what's going on, but I know this guy's probably got a heart injury judging from the ugly stab wound and the v-fib. 

    "You're right," Dr. Carter says, surprising me because I haven't realized I've been thinking aloud. "Probably an upward angle. Severity of stab wounds can be deceptive on first appreciation." He's got an intubation kit and is about ready to start, but then he looks up and scares the shit out of me by saying: 

    "I'm going to let you intubate." 

    In the adrenaline rush of chaos I'm not able to feel panic, but I look to Haleh and the other nurses for their reaction. They don't seem to notice, or else they don't care. Then I think of Dr. Benton wanting me to do procedures and I feel like I shouldn't protest. And, I did assist in one intubation when I was in pedes last month... well, I watched close, anyway. 

    "OK," I say, trying hard not to repeat everything Dr. Carter says to me as he talks me through it step by step. Visualize the vocal cords... but I can't see what I'm doing. "I -- I can't really see," I finally say. 

    "Yes you can, you've got great eyesight," Dr. Carter tells me calmly, but I try again and I just can't do what he wants me to. I can now feel every eye in the room on me, but I don't dare look up. I hear another doctor come in. She has an English accent, and I remember her from the surgical ward. "Carter, what have we got?" she asks. 

    "Stab wound, left fifth intercostal. Might be cardiac tamponade." 

    "All right, thoracotomy tray," she says. "Have you got an airway?" she adds, clearly impatient. 

    "We will in a moment," Dr. Carter says in a low voice, not quite so calm any more. "Try again," he says to me. 

    I can't. I just can't see. "Dr. Carter, I -- " 

    Dr. Carter shakes his head and grabs the intubation kit away from me, and I move quick out of the way. "Lydia, get ready to bag," he orders. 

    I move farther away from the table as the patient finally gets intubated and everyone else goes back into action. I know why Dr. Carter stopped me and I don't blame him -- because this guy's life was at stake -- but I still feel useless and incompetent as I stand there watching them do the thoracotomy. The stuff that thrilled me when I watched as a spectator a couple years ago now makes me feel a little sick to my stomach. There's nothing I can do but stand there and watch. 

    The guy flatlines just after they crack him. Dr. Carter shocks him with the internal paddles, but it's no good. They don't get him back. 

    Later, out in the hall, Dr. Carter comes up to me. "Intubations are tough to learn," he says simply. "That guy unfortunately probably wasn't going to make it anyway." 

    And I guess that's the end of that. 

    By lunchtime -- which I know I'm lucky to even get -- I'm feeling less disgusted with myself. I go down to the crowded cafeteria and sit down alone -- until, just like this morning, Dr. Benton walks by. This time, though, I don't much feel like stopping him. Just my luck that he sees me before I can leave, and comes on over. "Hey, how's it going?" he wants to know, and sits down across from me. "They keeping you busy?" 

    "I did two traumas," I shrug, trying to act like it's no big deal. 

    "Good, good," says Dr. Benton. 

    "Well, not so good," I admit. "One of the guys died." 

    "A lot of students find that they don't get that sort of exposure in their first week in the ER, much less their first day," he tells me. "You should consider yourself lucky not to be doing a lot of scut work." 

    "Actually... I was sort of expecting that on my first day." 

    Dr. Benton pushes away his salad and leans back in his chair. "Well, that's always been the tradition, and I went through it myself," he says, waving his hand dismissively. "I used to believe it was necessary, but it doesn't automatically make med students into competent doctors down the line." 

    I want to ask him if I'm getting some sort of special treatment, but of course, I don't. "Seems like a stupid tradition then," I say. "I mean, why stick to it so blind?" 

    Dr. Benton looks like he's never thought about it before. "Probably fear," he finally says. "Basic fear of doing anything new. Not thinking, not observing. On a basic level, that's bad medicine. And I've learned it's probably not the best way to teach, either." 

     I nod, and wonder how many students he's had, but I don't have time to ask because Dr. Carter has arrived out of nowhere. He's got an apple in his hand and starts shining it on his coat sleeve. He _really_ needs a shave at this point. "Hey, William. You'll need to get a pager," he says to me. "I just had the perfect patient for you." To Dr. Benton's questioning look, he clarifies, "Good patient for intubation practice." 

    My guilt overcomes me, and I explain to Dr. Benton about what happened in the knife trauma. I'm relieved when Dr. Carter starts talking instead about the v-fib and the complexities of atrial injury. Then he looks at me, gives me a little sideways smile, and takes a bite of the apple. "I've been keeping him busy," he tells Dr. Benton, mouth full. "Yeah, so, they guy didn't make it. But we won't kick you out for that," Dr. Carter says to me. "The first time you kill a patient doesn't count. The second time, however -- " 

    I smile because I know he's just making a dumb joke. But Dr. Benton doesn't seem to think it's funny. 

    "Wait," he says quizzically, cutting him off. "You had him intubating a critical patient?" 

    Dr. Carter seems to freeze for a moment. Then he recovers, nonchalant. 

    "I thought it would be good experience," he explains with a defensive smile and nod. "I mean, all things considered, he had no rhythm, no BP, he'd been down for twenty minutes, his sats were 75 and dropping..." As he continues, the nod becomes a sort of loose bobbing around until he's actually shaking his head instead. "He was a train wreck." 

    I can tell that Dr. Benton doesn't want to have this conversation in the middle of the cafeteria, and he lets a really uncomfortable silence hang there for a second after Dr. Carter trails off. 

    "I thought it would be a good opportunity for him," Dr. Carter then offers, giving me a glance. "If that's not what you recommended, well... I'm sorry." 

    He doesn't sound too sorry. He does sound a little pissed off, though. 

    "White, you ever put in a central line?" Dr. Benton asks me. 

    I'm caught a little off guard by this, since I've been desperately pretending for the last few minutes to be really interested in the Choking poster on the wall next to us. "Uh, no, not yet." 

    "Dr. Carter," Dr. Benton says, "I'm glad you called him in on a couple of traumas. But I'd prefer it if you didn't give him a baptism by fire next time when it comes to teaching him to do a central line. Or any other basic critical care procedures. That's not really what I had in mind." 

    Dr. Carter's face gets very tight, and he nods stiffly. "OK." He stands up and picks up his tray, then says to me, "I'm off at one, so when you come back from lunch, see Dr. Weaver." 

    "Thanks," I say, but he's already on his way out and I don't even know if he hears me. Dr. Benton starts in again on his salad, and I hope out loud that I'll do better next time intubating. 

    "Ahh, he should know better than that," Dr. Benton says, watching Dr. Carter leave the cafeteria. 

    "Yeah," I shrug, "but I never told him I haven't tubed anyone before." 

    Dr. Benton points his fork at me. "Hey," he says. "There's a lot you're not gonna know. But that doesn't necessarily mean that you have to let them see you sweat." 

    There's a grin in his eyes, but not on his face. Damn, he's cool. "So... you just want me to, like, look good?" 

    "Well, naturally. You're _my_ student," he shoots back, and then the grin comes up to the surface before he stifles it. "But," he reminds me, "don't be a hero. Use your judgment. I trust you." 

* * *

    So now I resolve to put Dr. Benton's kick-ass, sweat-free philosophy to work. I've only got four weeks in this rotation, and they're going by fast. I finally do learn to intubate -- on an old guy with emphysema -- with two nurses and one of the residents as my cheering section. That's a good day. I also learn to do a Foley -- well, I'd have a hard time saying that doing a Foley is ever "good," but at least I don't make a mess. 

    No sweat, huh? 

    Well, these days, I'm apparently not allowed to sweat. 

    It's Dr. Carter again. He's like a shadow in a white coat, following me all around the ER. I don't know what it is, but now he's constantly breathing down my neck. Even on basic stuff I already know. Whenever I'm putting in an IV, he's hovering. When I'm doing sutures, he's there. And now I'm taking a history in Exam Two on a teenage girl with a bad earache. She's complaining that she can't listen to her Walkman. 

    "So you're having hearing loss?" I try to clarify, going through the checklist in my mind. But Dr. Carter, who's walking down the hall, overhears me and sticks his head in. 

    "How's it going, William?" 

    "Good, just got an earache here." 

    "Earache, huh?" And he comes in! "Did you get a history?" 

    "I'm in the process," I explain. Now I feel like I have to report everything, so I mention the possible hearing loss. 

    "No," says the patient. "I mean, I can't listen because the headphones hurt my ear when I put them on. And my ear feels all stuffed up." 

    Dr. Carter looks at me, and before I can say anything, he reaches out and touches her ear gently. She yelps. 

    "Sorry about that, I won't do that again," he apologizes to her. "William, why don't you take a look inside." 

    I start the exam, beginning to feel stupid again. But if he hadn't interrupted me, I would have had a chance to get her complaint straight. "Been swimming lately?" I ask her as I look in the ear, trying to get a step ahead of Dr. Carter. 

    "Last weekend." 

    Dr. Carter tells me I'll probably find a swollen ear canal, and I do. Because she's got otitis externa, and I know that, and I used to see it all the time at Southside Pediatric during my internship there last summer. But Dr. Carter doesn't know about that, and I don't think he cares -- he just wants to handhold me in that ultra-polite way of his, because he thinks I don't know what I'm doing. 

    "So what are you going to do now?" Dr. Carter asks me. 

    I can't believe he's pimping me on an earache, but I realize that "no sweat" also means playing it cool when you want to tell someone where to get off. That's _people skills._ "Check for foreign bodies, irrigate the ear, suction out any fluid. Insert a wick and administer acetasol. Acetaminophen for pain. Hold off on the antibiotics, for now." 

    Dr. Carter just listens and nods, silent for a moment. He looks at the patient. 

    "You might also want to get a temperature," he says quietly, and not unkindly. "If it's hurting her that bad, she may have a middle ear infection that has to be treated concurrently, or possibly it's getting into cellulitis. In which case, she might also need some erythromycin." 

    He walks out. And I feel a little ashamed, because he's right. I did see this at Southside a lot, but always in fussy, crying kids -- and kids were always crying about everything there, so I tuned them out after a while. I should have paid more attention to the patient's reaction. 

    So much for people skills. 

    When I finish up with the swimmer's ear, I bring her chart to the desk. Malik, Connie and some of the other nurses are there, reading another chart and laughing. They show it to me. It's for a guy who came in with a Dijon mustard jar stuck up his rectum. I can't help laughing too. Does this stuff really happen? 

    "Guess you haven't gotten any yet," Malik says. 

    "Man, I always thought people were making all that stuff up." 

    "Aw, you've only been here a couple weeks," Connie tells me. "Stick around a little longer, you'll see it all. Handcuff removals..." 

    "Vacuum cleaner accidents..." Haleh adds. 

    "Carrots swallowed whole," says the Asian nurse, and everyone thinks this is very funny. I'm just confused, as usual. "How do you swallow a whole carr--" I begin, but I'm cut off by even more laughter. Ha ha ha! "Never mind, man, long story," Malik tells me. 

    I'm still feeling dumb from my latest run-in with Dr. Carter, so I tell them I'll believe it when I see it for myself. I tell them about some of the urban legends I've heard in the dorms -- like the one about the ER doctor getting brought into his own ER after a car accident, and not being recognized by the trauma staff until his wife shows up. 

    "Ain't no urban legend," Malik tells me, wide-eyed. "A few years ago it really happened down here." He says it like he's trying to scare me with a ghost story, so I don't know if he's kidding or not. The other nurses nod their heads in sudden agreement, but I notice that Haleh is shaking her head slowly, like she's sad. That's how I know it's not bull -- I watch Haleh. I'm learning. 

    "Yeah," Malik says, "Carter and Dr. Benton get called down for this trauma, and they bring in this poor guy who just got run over by the El, right outside." He grimaces at the memory. "Oh man, his face was all messed up. He was bad. And they're trying to get him stabilized. He was a train wreck." 

    "Malik, that's not funny," groans the Asian nurse. 

    "I didn't mean it like that," he says, eager to get on with the story. "So they're trying to call this other guy down to help put in a chest tube or something. And we're paging him, you know, wondering where the hell he is, 'cause he was always slow. And all the sudden -- right on the table..." He makes a high-pitched _beep beep beep beep_. 

    "It was the guy?" I say, sounding more mortified than I want to let on. 

    "Yeah," Malik continues. "He was a bro from Atlanta. Doing his surgical internship. Jumped right in front of the El. _Wham._" 

    "He didn't jump," insists the Asian nurse. "He could have fallen. They never knew for sure." 

    "Nah, it was a suicide," Malik says adamantly. "That dude was depressed. He was always getting slammed when he was down here. He just couldn't handle it." 

    "Oh wow, that is freaky," says one of the desk clerks, who's obviously never heard this story before either. 

    "Look it up on the Trib website, you'll find it," Malik insists. "But I can't remember his name -- " 

    "Dennis Gant," Haleh finally says in a loud, disapproving way, having taken this all in with no expression. She leaves her charts in the rack with a clatter and stalks down the hall. Ghost story over. 

* * * 

    Things get pretty quiet after that, but not for long. I'm getting a tutorial from Connie about the "turkey file" when a call comes in on the radio -- another trauma coming in. I find myself hoping it's not another shooting or stabbing. It's not. It's a single-car road accident, ETA ten minutes, Connie says. We all go outside anyway, even though we're probably not all needed. It's a really hot day, and I notice Dr. Carter shooting hoops in his lab coat. He's pretty good, actually. 

    "Aren't you roasting in that shirt?" Connie asks me. I've got my own lab coat off, but my dress shirt is still buttoned down to the wrists. I hadn't noticed. I roll up the sleeves a little bit, self-conscious all the sudden. 

    The ambulance pulls in, and it's just one victim. "What have we got?" Dr. Carter asks, running over. 

    "Seventeen-year-old girl, no seat belt, ejected from the vehicle, and it rolled over on her," says the paramedic, whose name is Doris. Even Connie sucks in her breath at that, but when they finally get the patient out, she fortunately doesn't look that bad. She's conscious and looking around fearfully as we bring her in. On the way, we run into Dr. Weaver, who also seems to be looking for action and invites herself to the party, ordering us in to Trauma Two. 

    Without waiting for anyone's approval, I listen to the patient's lungs, something I need practice at. "I'm getting decreased breath sounds on her right-hand side," I let them know. 

    Dr. Carter is right on it, confirming my observation. "Looks like we got some significant sub-cu emphysema here," he tells me, pointing to a small bulge in the side of the patient's chest. "That's something you don't see every day." He tells me to put my fingers on it. Man, it feels weird. He says it's probably from a tension pneumo. 

    "Sats are 90," Connie warns, "crit 40." 

    "Can you please take this collar thing off me," begs the patient. 

    I try my best to forge ahead and palpate her abdomen. I'm scared of hurting her, and she squirms. Definitely some tenderness, and I report it to Dr. Weaver. She orders 100 percent oxygen by mask, then asks me if I've ever cleared a neck before. 

    "No," Dr. Carter butts in quickly, "I'll do it." 

    "She's going to need a chest tube," Dr. Weaver reminds him. "William? You want to try a chest tube?" 

    "Neck is clear!" Dr. Carter booms. "Chest tube tray, Connie -- come on." 

    Connie gives him the blade and he makes a perfect incision. He is good, and _fast_. He's probably been doing these longer than I've been in college _or_ med school. But as impressed as I am, I also think this is getting ridiculous. This patient's not about ready to run a marathon at the moment, but she's nowhere close to critical. Does he think I'm going to kill her? 

    "William, over here," Dr. Weaver signals me. "I need a lavage kit." 

    "No, wait," Dr. Carter blurts, glancing up from the chest tube he's sewing in. Right now, he looks like Momma does when she's got pots boiling over on all four burners at Thanksgiving. It's funny. And I'd laugh. If I weren't getting so irritated at what he's pulling. 

    Well, I just go over to Dr. Weaver's side of the table, and start the lavage. I'm kind of shaky, and I know she's watching me close, but pretty soon I know I've done it right. I get about an inch of blood back from the tap. Great for me -- not so great for the patient. 

    "Positive," confirms Dr. Weaver. "Connie, call the OR. Good job, William." And in a couple of minutes, the patient's stabilized and we start moving her out toward the elevator. "Want to go take her up to the OR?" Dr. Weaver asks me. 

    "I've got some sutures for him to do down here," Dr. Carter says quickly. 

    Of course. 

    "Carter, I need a spinal tap done on a five-year-old with stiff neck and vomiting," Haleh pipes up from the corridor behind us. "Does William know how to do one yet?" 

    "No, I'll do it," Carter snaps at her. "I need him in sutures now, we're backed up." And he leads me to the empty suture room, telling me that Connie will be in in a minute with a patient and a chart, and leaves. 

    But five minutes go by, and nothing's happening. And I start to feel disrespected and forgotten again, which before today I would have tried hard to brush off like usual. But I remember what Dr. Benton said about looking strong, and about how Dr. Carter should know better, and I can't help it -- I'm just getting madder and madder inside. And by the time Dr. Carter finally comes back to the suture room, it's too late. 

    "Well, our arm lac in the waiting room went AWOL," he grumbles, fumbling around the 4 by 4's in the supply closet and not even looking at me. 

    "So," I manage to say, "is there anything else you want me to do for you right now, Dr. Carter?" 

    "Yeah, sutures," he says, not hiding his crabby attitude very well. "There's two other patients out there. I just wanted you to take that big arm lac first. I hope you don't have a problem with that." 

    That's it. "I don't have a problem with that, Dr. Carter," I tell him. "I'm just getting a feeling that you've got some kind of problem with _me_ today." 

    He just stares at me, pretending he doesn't know what I mean. Or maybe he really doesn't realize he's been treating me like a baby all morning. Whatever it is, it just makes me even more angry. 

    "I -- I just want to say something," I finally say, my voice shaking a little. "I came here to learn, not to watch." 

    Dr. Carter stops hunting for supplies, and my voice stops shaking as I look him right in the eye and continue. "It seems like you've been holding me back from trying things lately, and I just want to say that I think I can hack whatever this rotation has to throw at me, even if you don't," I tell him. "I'm a lot tougher than you think I am. I'm not going to go hide under my bed, or throw myself in front of the El, so you can stop treating me like I'm going to break or get hurt!" 

    Dr. Carter freezes when I say that. His eyes widen. His mouth drops open slightly. Oh God. I've just ruined my entire career. But I don't know how to stop what I've started. 

    "I'm not asking for special treatment," I go on. "I know you've probably had a lot of students. All I want is for you to take me seriously. Maybe I'm better than they were, or maybe I'm not. But I'd really appreciate if you could just take me seriously." 

    Dr. Carter is still just looking at me, like he doesn't know what to say. Oh man, I've said way too much. I'm getting the worst evaluation I've ever gotten, and I still don't know when to shut up. I respect Dr. Carter. I want to like him. But I've got to make my way through this world by myself. 

    "That's -- that's all I want," I say, my anger fading away. "That's all I wanted to say." 

    Dr. Carter is quiet for a moment, his face working. He doesn't look like a whipped dog. He looks suddenly sad and serious. Finally he says, "Thank you for bringing up your concerns with me." Turning, he absentmindedly picks up the 4 by 4's, tells me he'll send Connie in with the other lac for me to stitch up. 

    "When you're done, come find me and we'll work out your schedule for next week," he adds softly. Then he walks out. 

    I can't believe I just did what I just did. And I don't really know why, but I get the not too easy feeling that, somehow, more things around here are going to get said, before this rotation is over. 

(To be continued) 

   [1]: mailto:bankybooda@aol.com



	2. Part 2A

Students  
by Banky

Part 2 

  


    "Some people are going to tell you that a surgical career requires people who only have one-track minds," Dr. Benton says. "I'm here to tell you that it requires people of great sensitivity and a wide variety of strengths... only one of which is a one-track mind." 

    People around me laugh nervously. I'm sitting in the auditorium at the student union, surrounded by a couple dozen mostly first-years and a couple undergraduates, for Dr. Benton's surgical careers presentation. He's given this speech for a few years now, and when I went to it my first year of med school, that's how I became more sure than ever that this was the right choice for me. Also I remember how impressed I was when Dr. Benton remembered who I was right away when I went up to him after the lecture. I think that's when I decided to apply to the U of Chicago and not to some place I could have gotten in easier -- even though I really wanted to leave the area. 

    "Some of you have your minds made up, some don't. At this point I don't think I need to tell you that the more honest you are with yourself about your future direction, the better off you'll be," Dr. Benton continues. "The decisions never stop. Prepare yourself now. If you're a first-year, you need to decide now which concentrations you want to take for your second year. By this time of the school year when you're third-year, you'll have to think about meeting the application deadline for your sub-internship." 

    I don't belong here -- this talk isn't really aimed at third-years. So I'm sitting in the back, in the shadows. I don't know why I'm here really. Lately I've been thinking about that surgical sub-internship. I know Dr. Benton wants me to go for it, and I should. But then there's the internal medicine sub-i, and the pediatric. And the trauma sub-i... 

    "I see there's quite a few African American and Latino students in the audience," Dr. Benton goes on. "I want to start off by saying that all of you, in your own way, have had a challenge getting this far. You might have had financial challenges, or maybe not. Whatever your personal challenge, being a young person of color in med school takes a lot of mental energy from day to day, and sometimes you don't even realize how much. But that can make it harder for you to make decisions you need to make now, or to go that extra mile and maybe consider a surgical career." 

    Now the students sit up and look interested. None of the professors tells it like Dr. Benton does. He tells it like it is, doesn't sugar-coat it, and he says it in a way that makes even the white kids listen. 

    "How many people of color do you anticipate entering the surgical program here next year?" challenges a girl in the audience -- Peace Williamson; she's in my nephrology class. I'm watching her, mainly because she's very good looking, and then suddenly I realize that Dr. Benton has seen me. He looks surprised. 

    "We won't have exact numbers until the spring semester, but last year we had twelve new African American surgical interns starting their residencies, and I believe a slightly less number of Latinos," he answers her. "But we expect there's going to be a five to ten percent increase from last year." 

    He's looking right at me. 

    After the lecture, only a couple people stop up to talk. I go down too, and pretty soon it's just me and Dr. Benton. He guesses right away that I'm having trouble picking between sub-i's, and that that's why I came. 

    "You're only third-year. That's normal," Dr. Benton reassures me. "But you didn't have to come sit through this whole lecture -- you can always stop in upstairs if you need to talk about it." 

    "I think it's a pretty good lecture," I shrug. "I even saw a couple high school kids in the back." 

    "Yeah, we do afternoon programs for the kids from the charter schools," Dr. Benton says, "but the kids from the city find out about this somehow and just show up at night." He shakes his head. "To be honest," he sighs, "while I love to see them show up, most of them are just here because they're dreaming. Maybe one in fifty ever comes back. They're not doing school, and they haven't laid any groundwork, and... well, you don't like to have to tell them that it's probably too late for what they have in mind." 

    "But they could work hard and make it up," I say. 

    "Some can. _Some_," Dr. Benton says. "But in the end, all you can hope to do is reach the kids who aren't already in trouble, with more stable backgrounds who are committed already to hard work. Trouble is, they're all getting taken by the good engineering schools these days. And then, of course, when they do get into med school, it's hard to get them into an operating room." 

    Dr. Benton gets passionate talking about recruiting smart black kids for surgical careers. I know he didn't need to be lectured -- he always wanted to operate on people. He also doesn't believe in affirmative action -- he's told me before. He tells me again about how supportive his family was and how they managed to get him through school without breaking themselves. He had such a great family, I say. 

    "I was lucky," he says, "and so were you. City Tech is a great school and it's still got a fine college prep program, and it's even improved since I graduated." He knows I went to City Tech -- but only for one year, which he doesn't know. I went there after Momma and I moved. It's just never come up, that's all. 

    I change the subject. "That was a tough question there about the numbers," I say. 

    "Numbers aren't everything." Dr. Benton picks up his briefcase and then gives me a friendly look. "So hey -- what's your question?" 

    Sometimes I think Dr. Benton can look right through me. "Well," I say, "it's... kind of a weird question." 

    "Shoot." 

    I speak carefully. "Well, I was wondering... in your experience... who do you think saves more lives -- the surgeon, or the trauma physician?" 

    Dr. Benton seems taken by surprise. 

    "Another numbers question," he says. Finally, he answers, "I really don't know. Never thought it was important to think about. Everyone works together, or is supposed to. No one gets all the glory, if that's what you're asking." 

    "No, I --" It's not coming out right. "I mean... who's more responsible if they make a mistake? On a patient?" I don't know how to word this. "Who makes the most difference?" 

    Dr. Benton considers, and then just shakes his head. "I don't have an answer for that one." He sort of cocks his head a little, like he's just figured out where this is all coming from. "Hey man," he asks, "how _is_ that ER rotation going?" 

    "Fine," I tell him. I want to tell him that I think I've got things ironed out between me and Dr. Carter. Ever since I spoke up like that, things seem more normal. Dr. Carter personally gives me a work schedule every week now, and I'm never just stuck doing sutures any more. I think I handled it pretty good, taking charge like I did. Dr. Benton would approve, if I told him. But now I feel like I shouldn't mention anything more about it. It's late, and we've already talked too long. 

    Later, I'm in the nearly empty library, searching Medline aimlessly. I came to Dr. Benton's talk looking for answers I didn't get. I ought to be at home studying, but I don't feel like going home. I'm about to leave when I remember there was something else I wanted to find. 

    I log in to the Trib archive on the Internet, just out of curiosity. I can't remember the name of the guy who fell in front of the El, so I try a bunch of different search terms -- "intern," "student," "killed," "died," "County General Hospital" and all that. Finally, I get a hit. Two, actually. 

* * *

    "What have you found for us, Haleh?" Dr. Carter says, joining me and the other students and residents at the admit desk, and sounding way too energetic, like he's just drunk a whole pot of coffee. He's just started his shift, but I've been on since 7:00. He peers at the board. 

    "I've got a 70-year-old lady brought in from her nursing home with a rectal prolapse," Haleh offers sweetly. 

    "No thanks," Dr. Carter says, grimacing. "Mohamed, you take that one. I'll take the lower back pain." 

    No wonder Dr. Carter's so happy -- he's the attending and he never has to take any of the more distressing cases. This makes me happy too, because that means I won't have to treat them. I'm doing tag-team rounds with Dr. Carter these days more often than not. Sure enough, he motions for me to come along with him, and we go into Exam 3, where a white male in his mid-twenties is waiting on one of the beds. Dr. Carter examines his chart and asks him what's wrong. 

    "I just got done telling the nurse," the patient whimpers. "My back is killing me. I think it's my kidney -- it's a kidney stone." 

    Dr. Carter hands me the chart to hold, and I look at it while he hoists the patient into a sitting position and does an exam. "Watch me, William," he says. He demonstrates palpitation and percussion. The patient screams. "Sorry about that," Dr. Carter says. 

    Haleh comes in. "Urine's negative, no blood or crystals," she reports. She casts a critical eye on the wailing patient. I look at the chart to see if I missed anything. Pulse 90, BP 120 over 70, respiration 20. 

    "Dr. Carter?" I don't want to talk in front of the patient. Dr. Carter comes out into the hall with me, and I ask him if someone in that much pain shouldn't have a higher BP. 

    "That's a good question," he says quietly in a singsong voice, raising his eyebrows and scanning the chart. When Haleh comes out, he orders a spiral CT. "Radiology's backed up. Want me to check the turkey file?" she asks. 

    "Go ahead, but send him up anyway." 

    "Is he faking?" I whisper. 

    Haleh snorts. "Honey, if you ain't on all fours on the bed, you don't have a stone, and you don't get the Vicodin." 

    "Haleh," Dr. Carter admonishes her, writing the order. "Thirty IM of Toradol." 

    "Carter!" It's Abby, one of the nurses, shouting from down the hall. "We've got an impalement coming in. Right now." 

    "Wow, you don't see one of those every day," Dr. Carter says cheerfully. He zips across the hall to Trauma 2 and I follow him in as the paramedics bring in a bloody bundle. Unconscious, I hope -- it's a man with half a golf club sticking out of his collarbone. 

    "Bad shot on the eighteenth fairway," Doris the paramedic explains, "got mad, slammed the club against a tree, it broke, and then he tripped and fell on it. Good luck!" She snatches her backboard and escapes. 

    "Oh God," Dr. Carter groans, no longer cheerful after he gets a good look. "No wonder they couldn't intubate him in the field. We might have to take this out down here." 

    Then the man wakes up and starts thrashing around and screaming his head off. 

    "Push some Versed," Dr. Carter calls out calmly. I help Abby keep the man still, but then Dr. Carter swears a blue streak. The golf club has fallen out of the guy's neck, just like that, and blood is now spurting everywhere -- all over us, all over the floor. Dr. Carter calls for a clamp. "William, go get Malik. We're going to need some more help in here." 

    I back out and turn to go, but I run into someone. It's the kidney stone guy, standing there half dressed. He's not supposed to be in here. 

    "My back is killing me," he moans desperately. "I need something for the pain. Nobody gave me anything that works." 

    I try to tell him that he'll have to wait outside, but he isn't listening to me. "I said I need something!" he screams in my face. Then he grabs my wrist, hard. I manage to break free, but he follows me. I catch just the slightest glimpse of something short and silver in his hand. Then there's a gasp -- Abby, the nurse -- and he piles into me, shoving me against the table with the intubation kit on it. 

    Suddenly someone grabs me from behind with strong arms and quickly shoves me to the floor. It's Dr. Carter. He's now standing between me and the kidney stone patient, who's sweating and confused and looks about to throw up. Dr. Carter's arm is outstretched, his hand reaching out, shaking. But right when I think we're both going to die, Malik and three security guys show up, and they grab the guy. The silver thing falls out of his hand onto the floor. He doesn't resist. 

    "Abby, you got the clamp?" Dr. Carter asks, looking back at the patient on the table. "William, you okay? You all right, William?" 

    Malik picks up the silver thing. "Oh man," he laughs. "Look at this. It's a church key, man!" He waves it in front of Kidney Guy's nose derisively. "Yeah, you a real badass. Come back when you're serious, dude. Heh heh." 

    I just sit there on the floor, dazed, watching as Malik, Abby and Dr. Carter resume working on the golfer while Security hauls the other patient away. My lab coat's covered with the blood that was on the floor. So is Dr. Carter's. By the time I get up on my wobbly legs, they've got him stabilized, and Abby and Malik are taking him up the OR. It's just me and Dr. Carter and a lot of blood. He lets out a big, unsteady sigh. "You okay?" he asks me again. 

    "I think I just got the wind knocked out of me," I tell him. "Are you okay?" 

    "Yeah, I think so." He looks down at his bloodstained lab coat. "But I think we need to take a short break." 

    We stagger down the hall to the men's room, and on the way Dr. Carter picks up a stack of scrubs from a supply cart. Man, I always wondered why there seemed to be such an endless supply of those things around. Now I think I'm getting an idea. In the men's room, I take off my bloody coat and realize it's ruined. There's also blood on my cheek somehow, so I go to wash it off. Dr. Carter takes his coat off too, but he just stands there at the sink for a second, then slumps down to lean on it, covering his eyes with his hand. 

    "Oh," he finally sighs, sounding exhausted. I see his shirt is also sprayed with blood from the gusher artery. He unbuttons the shirt and throws it into the trash. When he stops to unfolds one of the scrub tops, I can see he's got a couple of big scars on his back. They look like fight scars, but I'm sure they're not. He doesn't seem self-conscious at all, or even aware that I'm looking, but I don't want to stare. I look down quickly. 

    "Are you all right?" Dr. Carter asks me again as he pulls on the scrub top. "That guy knocked you down pretty hard." 

    "Actually, I think you did that," I say. "Thanks." 

    Dr. Carter shrugs, and smiles. He tells me that sometimes you do caught up get violent incidents working in a city ER. "I was hoping that was one ER experience you weren't going to get while you were here." 

    "Do I get extra credit for fighting drug-seeking bad guys?" I ask him. 

    He laughs. "No, I'm afraid not." 

    It hits me that, in the space of five minutes, I went from trying to save some poor guy's life, to getting nearly killed by a crazy junkie, to having the first decent talk with Dr. Carter that I think I've had. My head is spinning. 

    "William," Dr. Carter says suddenly, "there's something wrong with you." 

    What does he mean by that? 

    Then I follow his look and see there's a smudge of blood on my shirt front. "Oh," I say. Dr. Carter produces a second scrub top from the stack he brought with him, and tosses it to me. "Actually, that's okay," I tell him, putting it down. "I'd rather not." 

    "You don't want to change?" He sounds surprised. "You know, med students are allowed to wear scrubs. I won't mark you down for it." 

    I chuckle, a little too hard. "No, that's all right, Dr. Carter, it's not even really a big spot. I think if I get a new lab coat, though, it ought to cover that right up, for now." I see that Dr. Carter isn't quite with me, so I tell him that I think it's important to look good. "You know, in front of the patients," I add quickly. 

    "So professional," Dr. Carter comments. 

    I start to feel self-conscious, but his tone is not mocking or joking. 

    "Benton must love you," he says. 

    He looks sad. I shrug as best I can and keep my eyes down on the sink as I finish up washing my hands. When I look up, Dr. Carter seems like he's a million miles away. 

    Then he just says we'd better get going. But he waits for me as we're going out, and he gives me an awkward little pat on the arm before we go back to work. 

NEXT: THE CONCLUSION


End file.
